Who Cares?

The wound from Celester's feeding tube still hasn't completely healed.

Daniel Kramer

He was unconscious and moaning loudly when the medic arrived to find him on the floor of the civilian workers' tent -- officially B-hut No. 13 -- in Afghanistan on November 30 last year. In response to "painful stimulus," all Celester Hall did was open one eye, his left.

The 53-year-old truck driver from East Texas couldn't answer questions, and no one had seen him fall. There were dried urine stains on his shorts, but no one knew how long he'd been there.

Hall had gone into the civilian clinic at Bagram Air Force Base three days before, complaining of aching all over and sweating when it was cold. KBR medic Charles Dusha had given him ibuprofen, extra-strength Tylenol and a decongestant, and had assigned him to quarters, allowing him to stay in his cot for a few days. Obviously, things had gotten much worse in a hurry. This was beyond what the medic could handle. They scooped Hall up and took him over to the U.S. Army's 325th Combat Surgical Hospital.

Sedated, paralyzed and intubated, Hall was placed on a ventilator and taken for a CT scan that didn't show any gross bleeding or any mass or lesion. They thought he'd had a stroke.

On December 1, Hall was airlifted to Germany, his destination the Landstuhl Regional Medical Center.

Hall had signed on with the Kellogg, Brown & Root/Halliburton subsidiary Service Employees International, Inc. to make his fortune. But somewhere along the way, in the dusty cab of a supply truck or in his cramped living quarters, his luck had run out.

At the Landstuhl army post, Hall was diagnosed with strep pneumonia meningitis, aspiration pneumonia and nerve dysfunction. The inner layers of his brain were inflamed, rendering him totally helpless. Back in Bryan, his wife, Bema Johnson-Hall, heard of his critical condition through other employees. She called KBR, got a hurry-up passport and readied herself to join him.

On December 2, Hall was given a lumbar puncture. Doctors stopped sedating him, tried to clear away the cloud of drugs. His mental status did not improve.

They brought in a neurologist on December 3. Hall wasn't doing any better. He didn't open his eyes to any stimulation.

The next day an anxious Bema was told not to worry about going over to meet her husband; they were sending him home. On December 5 he was transported to Methodist Hospital in Houston via Air Med International. From there, he went to Kindred Hospital in Houston, an acute-care facility, and then to the St. Joseph Regional Rehabilitation Center in Bryan. Along the way, he'd had a feeding tube put in, as well as a tracheotomy to help him breathe.

On February 17 he went home to his house in Bryan.

Celester Hall, a man who had regularly played basketball and baseball and walked for exercise, a man who drove long distances on his truck routes to help support his wife and their blended family of three teenage children, was now deaf. His eyes weren't opening. He'd lost his balance. He'd had a stroke.

He had to be catheterized and eventually would graduate to wearing adult diapers. His hearing loss appears to be as permanent as it is profound. A cochlear implant did nothing to improve the condition -- it just made him more susceptible to infections, according to his wife.

Before he went overseas, Hall was handed some KBR literature, indicating that he and other contract workers had a special role to play in the Afghanistan theater.

"KBR employees are not contractors, we are Force Multipliers We are as close to being soldiers as we can get without saluting and carrying a gun," the KBR/Halliburton literature reads.

All in all, it was a sorry end to a high-risk gamble.

And it got worse. In the spring, when Bema was standing in a drugstore waiting on one of Celester's prescriptions, she was told her Cigna group health insurance had been canceled. It was canceled because Celester's employment had been terminated.

She applied for workers' comp through Service Employees International, Inc. KBR contracts with the insurance company AIG WorldSource to handle international claims. One of AIG WorldSource's Dallas-based adjusters, Joseph Johnson, turned her down, writing to her in a letter that Celester wasn't eligible for coverage. She started looking for a lawyer.

By late May, she and her husband were in a Houston courtroom with attorney Lewis Fleishman arguing that SEII should be covering the medical bills, which by then totaled more than $100,000.

And, as she testified before a Department of Labor administrative law judge, Bema Johnson-Hall had discovered that December 1 -- the day her husband was hanging on to his life during his nine-hour flight to Germany -- was officially his last day of employment.

His employer had terminated him, retroactively, to that date.

Celester Hall ended up before a federal administrative law judge because, as a civilian worker supporting the troops, he is covered under the Defense Base Act, an extension of the Longshore and Harbor Workers' Compensation Act, a special form of workers' comp.

The Defense Base Act provides "compensation for disability or death to persons employed at military, air and naval bases outside the United States."

To be covered, all a person has to do is show that while he was living or working overseas for a company in support of the troops, he encountered a disabling illness or injury. No one has to prove negligence, just that the illness or injury arose from "conditions of employment," Fleishman says.

If a permanent total disability is established, then under the Defense Base Act, the employer's insurance company is required to pay the person two-thirds of his average weekly salary for the rest of his life.

Unfortunately, a lot of overseas civilian workers have no idea the act exists, says Houston attorney Gary Pitts, who handles several such cases. "The legal requirement is so obscure: a poster in their office," Pitts says. "I've never heard any of my clients say there was a poster in the Quonset huts or tents."

Companies do mention the Defense Base Act in their contracts, he says, and if employees ask the companies specifically about the act's provisions, they don't deny its existence.

In an e-mailed response, Halliburton spokeswoman Melissa Norcross said that "a KBR representative thoroughly explains the company's health care benefits for employees and their families. The company clearly explains that the Defense Base Act (DBA) will be provided to every employee. Employees also receive explanations regarding what the DBA is and how it works."

But according to Pitts, there's been some misinformation handed out at Halliburton job fair meetings. Client Carole McNair of Houston says she asked what would happen if her husband, Roy, died overseas. Would she be entitled to only the $25,000 life insurance policy KBR gives its employees? According to her, a KBR representative stood up and said: "We're working on it, but yes, that's all." (Roy McNair hurt his back in Iraq while working as a KBR truck driver, and a year and eight months later, the McNairs are still battling with Halliburton over his compensation.)

In reality, if a widow makes a claim during the year after her husband's death, she's entitled to one-half of his salary for the rest of her life, Pitts says. In response to a question from the Houston Press, KBR acknowledged that there might be additional payments due a widow in such a case.

A salary of $80,000 a year would mean $40,000 a year to a widow, Pitts says. If she lives 50 years beyond her husband's death, that would be $2 million. That would be $2 million that the insurer doesn't need to pay out. Lower payouts means better insurance rates for KBR, Pitts points out.

Not many attorneys like to do Defense Base Act work, according to Pitts. Most clients live in remote areas, making meetings difficult. The pay, set by the Department of Labor, is below normal billing levels, he says. Many of these cases drag out for months, although the Department of Labor has recently put them on the fast track. The number of adjusters in the Dallas office of AIG WorldSource increased from three to seven just recently, Pitts says.

Of course, the attorney and the family get nothing if they lose.

Celester Hall has an 11th-grade education. As court records show, he worked for a local Texas trucking firm in which he made $6,240 for 15 weeks of work (that works out to $21,632 a year). Afghanistan, with the expectation of $80,000 in annual pay, meant a better life.

He'd already worked for Halliburton in 2003 -- in Kuwait -- but returned when his wife had complications from gastric bypass surgery. He has relatives among the Afghanistan support workers, so he was ready to try it again.

He lived in a 20- by 35-foot Bravo hut with eight to ten people. Each man carved out about a seven- by nine-foot space for himself, constructing dividers out of sheets or carpets bought from the bazaar or the PX.

Bagram Air Force Base is surrounded by barbed wire and a minefield with an eight-foot chain-link fence with concertina wire on top. None of this is any protection against the dust and dryness that cause respiratory problems to last longer than normal -- the same conditions that wreaked so much havoc on the Soviet army when it battled Afghan fighters for ten years starting in 1979. According to medical accounts, some 43 percent of the Soviet military had acute pneumonia during the first year in Afghanistan.

Things hadn't improved much by 2004. In a long-distance deposition in Hall's case, interrupted by a sandstorm, medic Charles Dusha said he and a nurse were seeing 70 patients a day. He estimated that on base there were 10,000 to 15,000 military personnel and about 1,000 KBR employees and a dozen smaller contractors -- as well as 500 to 1,000 locals doing manual labor.

There is a meningitis vaccine that, according to one leading proponent, Dr. Daniel Musher of Baylor College of Medicine in Houston, decreases the probability of a serious pneumococcal infection by 60 to 70 percent. But it is not routinely given out to civilians or by the U.S. Army. Civilian workers do receive immunizations against hepatitis A and B, polio and typhoid.

KBR's medical facility, at least at Bagram, appeared to be a bit Spartan both in number of medical personnel and space available. When Celester Hall was brought in, the medic did not perform a spinal tap. Dusha wasn't qualified to do so. The nurses and doctors at Bagram didn't do one either. According to Dr. Musher, an authority on streptococcus pneumonia and pneumococcal meningitis, a spinal tap should not be delayed.

Which begs the questions: If Hall had contracted meningitis back in Texas, would the treatment have been better; would his suffering have been so severe; would he now be deaf?

Attorney Pitts has been representing Gulf war vets for 12 years, suing the companies that sold chemical weapons to Saddam Hussein. Now he's also representing overseas civilian workers.

He and Lewis Fleishman are friends; both are passionate about the clients they represent, but with different styles. While Pitts tends to talk in big-picture terms and doesn't hedge too much about his views on the use of civilian contractors, Fleishman is far more circumspect -- outside the courtroom, anyway -- saying he concentrates on one client at a time, hoping to work out the best possible relief for each one.

Bema Johnson-Hall likes to recall how when she finally reached Fleishman to tell him her story, he jumped in his car and drove to Bryan to see her husband. "Lewis doesn't care about the money," she says. "He cares about us."

Pitts seems to share that idealism. As a youth, he went to West Point. He left the academy because he thought the Vietnam war was unconstitutional. He joined the Army National Guard for 12 years starting in 1975 and rose to the rank of captain. He supported both the Gulf wars and our entry into Iraq.

Which doesn't mean he likes everything going on there.

"Plainly ridiculous" is how he characterizes some of the maneuvering by companies trying to get out of paying for overseas civilian workers' illnesses or injuries. Client Mark Baltazar was in a mess hall near Mosul last December when a suicide bomber blew it up. As a result, Pitts says, Baltazar needs a hearing aid. Pre-employment, the Houston resident had a moderate loss of hearing at high frequencies but did not require a hearing aid. KBR is refusing to pay, Pitts says. They are still waiting to have another hearing test scheduled.

A hearing aid costs about $500. Court costs for fighting this case would tend to run $20,000 for the defendant's attorney and $15,000 for the claimant's lawyer, Pitts says. So why incur these kinds of legal costs for something relatively inexpensive?

Even if KBR or any contractor loses, Pitts says, it doesn't absorb the expense, because it has a cost-plus contract with the government. KBR will pay the attorneys on both sides "and give the bill to the U.S. government," he says. "The taxpayers pay."

Later she wrote that KBR automatically files a DBA claim with AIG on behalf of any employee injured or killed while working on a government project overseas. "It is not up to KBR to accept or deny an employee's claim the responsibility for the claim is transferred wholly to AIG and is no longer under KBR's purview."

With so few attorneys willing to take on these cases, self-insured companies -- as well as ones like KBR that contract out their insurance -- stand to win often when they refuse payment, Pitts says.

"The people they're screwing here are the widows and children of heroes who are going over there to support the war effort," Pitts says.

The parent company AIG is the target of several regulatory inquiries -- the U.S. Securities and Exchange Commission has been investigating it, for one -- but AIG WorldSource spokesman Joe Norton says none of these investigations involve his subsidiary. He also denies that his company tries to get out of its responsibilities by fighting claims it should honor.

Just because a company files a so-called controversion, that doesn't mean it's necessarily ducking its responsibilities, according to the U.S. Department of Labor. It may mean that it's just making sure that it doesn't face any penalties for not filing a form in time, according to one official who did not want to be named.

Pitts says it's true that sometimes companies will withdraw their controversions. But when they don't and it involves someone being hurt overseas, the worker receives nothing while waiting for the case to be settled, he says.

"I've had people going on welfare. I've had grown men moving in with their mothers. They become homeless," he says. Not giving them anything while the case is pending is another way, he says, that a company can pressure a former employee to settle out of court for less money.

According to the U.S. Department of Labor, as of August 4, there have been 3,603 Defense Base Act claims filed by workers of all nationalities through July 27 out of Iraq (of which 116 are deaths). The Texas portion of this was 625 claims, of which 19 are deaths.

Pitts doesn't think civilian workers should be used in our present conflicts in the Middle East.

"Somebody in the Pentagon had the bright idea during the cold war called 'outsourcing' for the military," Pitts says. By bringing in support workers, the trained soldier would be freed up to do his primary job of fighting and defense. Also, it would be more economical to do it this way, since you wouldn't have all these support units sitting around during peacetime.

"But this only makes sense if there are front lines and you have a conventional war and a short war. Nobody planned for this."

Support personnel should be armed and trained to defend themselves if we're going to be in a longtime guerrilla war, Pitts says. "In the traditional army, the privates do the truck driving. It's less expensive and more efficient to handle in a traditional way if we're going to face the reality of extended conflicts."

Of course, to do this would probably mean reinstating the draft, Pitts says.

"It appears the American people are more willing to pay unarmed truck drivers $80,000 a year and hit the streets in Iraq without any weapons to defend themselves than to face the reality of common sacrifice that is a draft."

KBR's Norcross wrote that the use of civilian workers to drive trucks, deliver water and fuel, cook meals, wash laundry and deliver mail was a "public policy" decision, "best left to government authorities."

"KBR employees and subcontractors understand the dangers and difficult conditions involved in working in a war zone and have made courageous decisions to deliver the services necessary to support the troops."

Security for KBR employees is provided by the U.S. military, she wrote, adding that all KBR truck drivers are intensively trained in defensive and evasive driving techniques and how to check for bombs.

Inside a courtroom on the seventh floor of the Federal Building, Celester Hall sits quietly at the plaintiff's table, his rolling walker to his left. The black cochlear implant is visible on the right side of his head.

Officially, his suit is against SEII and the Insurance Co. of the State of Pennsylvania, an underwriting company with American International Group. KBR/Halliburton is out of it, not considered an employer for purposes of the lawsuit.

Attorney Fleishman says he doesn't care whose name is on the suit as long as someone steps up to pay Hall his due.

The atmosphere in the courtroom is amiable. On May 20 some stipulations were signed; SEII has accepted this as a "compensable case," meaning SEII or its insurance carrier is going to do something for Hall.

"We absolutely want to get Mr. Hall what he needs," says John Schouest, a Phelps Dunbar attorney representing SEII. His questions concern the amount of improvement Hall has made so far and what can be expected in the future. He argues that a re-evaluation is in order.

Fleishman points out that so far SEII's track record has been "abysmal" in terms of taking care of Hall, but he welcomes the change in attitude. He recites a list of needs, among them: home health care attendant, prescription medicine, another cochlear implant and physical therapy.

His client has third nerve palsy in his eye, balance problems, ophthalmologic needs, urologic infections and mileage payments for medical care, Fleishman continues. They are here because there were no responses to earlier letters to SEII asking for help in paying the bills, Fleishman tells Judge Clement J. Kennington.

He points to a chart, written by Baylor's Dr. Musher. On it, Musher, recognized as a leading authority on infectious diseases, has listed common factors that lead to streptococcal pneumonia and meningitis: stress, fatigue, dust and overcrowding. They mirror Celester Hall's experience in Afghanistan.

Hall peers at a computer monitor. Since he can't hear, a specially retained court reporter types out the attorneys' questions, which appear on a screen before him.

Finally, he takes the stand. He's 54 now. Never got his GED. In his thirties he switched from working construction to driving trucks.

Since his treatment for meningitis, he's had some improvement to his vision, but it's not right yet.

"I kind of get double vision when you go to my left I see like two. I'm not getting a real good focus," he explains while Fleishman waves a pen in front of him, asking him to track it.

His balance is still off. "I can't hold a steady line when I walk."

He's still having bladder problems. "I haven't been able to hold my urine all the time." He's had continued bladder infections. He wears Depends. He's been shown how to catheterize himself but isn't especially good at it, so mostly his wife does it.

And now he's got sores coming out on his head.

He uses a Fisher-Price children's wipe board to communicate with his wife. He can't drive.

His wife tells a similar story when it's her turn to testify. Bema Johnson-Hall will have been married to Celester for five years this coming October. On the witness stand she describes their life since Afghanistan.

Every morning she gets Celester breakfast, helps him dress and goes off to work, which is only minutes away. She returns around noon to bring him lunch. After she gets off at 5 p.m., she gets him dinner and then goes off to her second job, where she works till 9 p.m.

Then on Saturdays she goes to her third job, covering phones in a real estate office. She has to do this to pay the mounting bills, to pay for the prescription drugs out of her own pocket. They go through a bag of adult diapers every two weeks.

Her husband suffers from depression. "He doesn't want to eat. He cries. He says he doesn't want to live anymore," she says. Since the cochlear implant doesn't work, he feels worse. She'd like to have him get psychological counseling. "He's always been a cheerful person."

When Celester was in Afghanistan he was usually on a water truck as an escort, and one of the Afghan men drove. The trip was 40 minutes out and 40 minutes back, not counting the time it took to dump the water at a site provided for by the military. He was riding with one Afghan who was really sick for about a week.

It was crowded and dusty inside the hut. It was always dirty. They kept it cold to discourage the rats and spiders from coming in through the cracks along the electric pipes. He bought masks from the store.

His work schedule was seven days a week, 12 hours a day. Critics say SEII was incorporated in the Cayman Islands to get around U.S. labor laws. No overtime is paid. KBR says it does comply with U.S. law, but different standards apply with overseas incorporation and they -- just like other companies -- pay straight time for work in excess of 40 hours per week.

When Celester first got sick, the medic told him it might have been due to the elevation and that he didn't drink enough water.

He starts crying on the witness stand when he tells about first seeing his wife in the hospital. He didn't know where he was; Bema got a writing board and told him all the things that had happened to him.

He shows the sore in the middle of his stomach where they put in the feeding tube. It hasn't quite healed. His wife replaces the bandages. He has burning and pain in his hands and feet.

Most days he sits at home, where he reads his Bible. He can't answer the phone. He went to church on Easter Sunday but hasn't gone much since because he can't hear anything. His wife helps him bathe or shower.

Asked what he wants by the attorney for his former employer, Hall says he wants to be restored.

"Help me get better so I can enjoy life. I miss a lot of things I used to be able to play sports, and now I can hardly walk."

Civilian worker Sam Walker was in the KBR chow hall at Camp Merez in Iraq when a suicide bomber blew up the place, killing 22 people and injuring more than 50 others on December 21, 2004. Walker suffered shrapnel wounds to his hand, head and leg. He picked bits of flesh off himself after the explosion. He's being seen by a psychologist for post-traumatic stress disorder.

He hasn't received any benefits from KBR.

The 43-year-old has problems with anxiety, sleep disturbance and hypervigilance, Pitts says.

Rates of PTSD among those serving in Iraq are much higher than from the first Gulf war, Pitts says. "The first was a war that lasted six weeks, and only three days were a ground war. This is a chronic guerrilla war, no front line. The first war had a front line. There are a lot more soldiers that are actually having to engage in house-to-house fighting and actually shooting the enemy and seeing them."

The U.S. Army counsels people before they leave the theater of war, Pitts says. It has instituted a policy of following up after they return to the States. There's been a learning curve since Vietnam.

The civilian contract workers who are exposed to the war zone don't have the same treatment, Pitts says.

A country goes to war, and it recruits young people to fight for it. In the case of civilian workers, however, the average age tends to be higher.

"You want the demographics on some of my clients?" asks Pitts, leafing through his files. He finds a 64-year-old truck driver, another man who's 63, another 58. "The average age is significantly older than those in the military."

Bema Johnson-Hall met her future husband through a friend of her brother's. At first, she wouldn't go out with him. A year later she agreed to start dating. A while after that, they got married.

Celester's world had been pretty much restricted to East Texas and Houston, she says. "He really hadn't had a whole lot of things in life." She had always traveled, and they started going places together. They dreamed of buying their own home for themselves and their children -- her son, now 15, from her first marriage and Celester's 15-year-old daughter and 13-year-old son from his.

Bema was taking nursing classes but had to drop out when everything went so wrong with her husband, she says. She doesn't know when she'll get back.

Two months after his court hearing, some things have improved for Celester and Bema. They were disappointed to find out the May 31 hearing didn't settle anything -- a mediation was tentatively scheduled for August 11, and a post-hearing brief is due to the court on August 15 -- but now at least there is some money coming in.

In late June, Bema says, they got temporary total disability benefits for Celester retroactive to December 1. He receives two-thirds of his average salary for the previous year, or about $500 a week from the insurer. She has been able to cut back to just two jobs: her full-time day job and some part-time billing on the side.

Attorney Fleishman expects the case to be decided sometime late this year or early in 2006, and at that point the administrative law judge will enter a ruling determining whether the insurance company will have to pay Celester. The payments right now are voluntary, he says.

Bema is back in touch with Joseph Johnson of AIG WorldSource (he returned a phone call from the Press and referred all questions to his company's New York corporate spokesman), who is in charge of authorizing coverage for them for things like doctor's visits, physical therapy and medicines. She has asked for help in the home. She says Johnson said they had to have an assessment in the home by a case manager, which was done, but after three weeks, nothing has happened.

The care and love are obvious as she bathes her husband, soaping his head and body while he sits in the bathtub. She still catheterizes him, and the new routine of her life includes frequent doctor visits. The signs of wear are there in her voice. She needs some help. Occasionally she raises one finger in front of Celester. That means she's just one person, working as fast as she can.

Celester says he gets nothing but "a real low kind of static, like a broken speaker" from his cochlear implant. He wears the diapers less frequently now but still needs them for longer trips out, such as doctor's visits. He still navigates by rolling walker.

Doctors have said it'll be one and a half to three years before they can determine what he's really going to be like, Bema says.

Deposition testimony from medical experts was not encouraging.

Dr. Kelly Loeb of Central Texas Rehabilitation Medicine in Bryan, who saw Celester as an outpatient and who does physicals for the Department of Transportation, gave Celester a poor prognosis for returning to work as a truck driver.

Dr. Newton Jasper Coker of Houston, who examined Celester for his auditory problems, said Celester had no hearing, a complete loss at all levels. Even if the cochlear implant suddenly started working, Celester would not hear normally. Celester, he said, would not be able to ride a bike or perform any complex activities.

Dr. George Burnazian, an infectious disease specialist in Houston, said: "Well, I think that this man is, in my opinion, crippled by this episode."

Ginny Stegent, a registered nurse for 32 years, is a life-care planner for Med-Legal Services. Her job is to look at a disability and put a price tag on it. She interviewed the Halls five and a half months after he became ill.

"Mrs. Hall said he will speak of things that did not happen Mrs. Hall says he cries and feels he is shut off in a world by himself," Stegent testified. She recounted an episode in which Celester called his wife by cell phone to come back to the house. He didn't want her to leave.

"My husband's been through so much," Bema says. "This almost cost us everything we own. The only reason they're paying now is because I got an attorney."

She still has several relatives over in the Middle East, hanging on to civilian jobs. She says Celester told her that the Americans need to be gone from there.

"He said, 'We are going to a country that doesn't care anything about us. What I think is we need to pull out and let those people have their country back.' "

The overseas venture, Bema says, "was supposed to be all this money and tax-free" for them. Because Celester didn't stay the minimum 330 days outside the country, he loses the tax-free provision under U.S. law.

She married Celester because he was "helpful and very loving, a family man and people person." She talks often about the smile he always had.

These days he's become querulous and suspicious, frustrated and dependent on others. Bema says all she hears from his former employer and its representatives is that they want to get Celester back on his feet and back to work. "We're talking about somebody's life," she says in frustration.

It's clear, though, that the life they dreamed about, and the people they were once upon a time, aren't going to happen again. They're just trying to make the best of what they have left.